| NPI | 1174074116 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 055.0031631) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C06245) |
| 363A00000X Physician Assistant (Licence: PA MA058666) | |
| 363AS0400X Physician Assistant Surgical (Licence: MD C0006245) | |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2022-11-11 |